Atrial fibrillation and pregnancy: prevalence, treatment approaches


DOI: https://dx.doi.org/10.18565/therapy.2021.1.116-123

Poteshkina N.G., Domasheva M.N., Khadgezova A.B., Selivanova G.B., Krylova N.S., Svanadze A.M.

N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia, Moscow
Abstract. The article focuses on the prevalence of atrial fibrillation during pregnancy, difficulties in prescribing antiarrhythmic therapy in pregnant women, taking into account the possible adverse effects on the fetus. A review of literature data on the comparative effectiveness and safety of antiarrhythmic drugs is given. The choice of anticoagulants in different periods of pregnancy for the prevention of thromboembolic complications is discussed, taking into account the risk of bleeding on the part of the mother and safety for the fetus.
Keywords: atrial fibrillation, pregnancy, antiarrhythmic therapy, anticoagulant therapy
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Literature


  1. Knotts R.J., Hasan G. Cardiac arrhythmias in pregnancy. Semin Perinatol. 2014; 38(5): 285–88. doi: 10.1053/j.semperi.2014.04.017.

  2. Silversides C.K., Harris L., Haberer K. et al. Recurrence rates of arrhythmias during pregnancy in women with previous tachyarrhythmia and impact on fetal and neonatal outcomes. Am J Cardiol. 2006; 97(8): 1206–12. doi: 10.1016/j.amjcard.2005.11.041.

  3. Vaidya V.R., Arora S., Patel N. et al. Burden of arrhythmia in pregnancy.Circulation. 2017; 135(6): 619–21. doi: 10.1161/CIRCULATIONAHA.116.026681.

  4. Lee M.S., Chen W., Zhang Z. et al. Atrial fibrillation and atrial flutter in pregnant women-a population-based study. J Am Heart Assoc. 2016; 5(4): е003182. doi: 10.1161/JAHA.115.003182.

  5. Salam A.M., Ertekin E., Iris M. et al. Atrial fibrillation or flutter during pregnancy in patients with structural heart disease data from the ROPAC (Registry on Pregnancy and Cardiac Disease). JACC Clin Electrophysiol. 2015; 1(4): 284–92. doi: 10.1016/j.jacep.2015.04.013.

  6. Regitz-Zagrosek V., Roos-Hesselink J.W., Bauersachs J. et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018; 39(34): 3165–241. doi: 10.1093/eurheartj/ehy340.

  7. Pijuan-Domenech A., Galian L., Goya M. et al. Cardiac complications during pregnancy are better predicted with the modified WHO risk score. Int J Cardiol. 2015; 195: 149–54. doi: 10.1016/j.ijcard.2015.05.076.

  8. Balci A., Sollie-Szarynska K.M., van der Bijl A.G. et al. Prospective validation and assessment of cardiovascular and offspring risk models for pregnant women with congenital heart disease. Heart. 2014; 100 (17): 1373–81. doi: 1373-138110.1136/heartjnl-2014-305597.

  9. Pregnancy, lactation, and reproductive potential: labeling for human prescription drug and biological products-content and format: guidance for industry. Food and Drug Administration, 2014. Available at: www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM425398.pdf (date of access – 10.01.2021).

  10. Kirchhof P., Benussi S., Kotecha D. et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016; 37(38): 2893–962. doi: 10.15829/1560-4071-2017-7-7-86.

  11. Kockova R., Kocka V., Kiernan T., Fahy G.J. Ibutilide-induced cardioversion of atrial fibrillation during pregnancy. J Cardiovasc Electrophysiol. 2007; 18(5): 545–47. doi: 10.1111/j.1540-8167.2006.00752.х.

  12. Katritsis D.G., Boriani G., Cosio F.G. et al. European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE). Europace. 2017; 19(3): 465–511. doi: 10.1093/europace/euw301.

  13. Cacciotti L., Passaseo I. Management of atrial fibrillation in pregnancy. J Atr Fibrillation. 2010; 3(3): 295. doi: 10.4022/jafib.295.

  14. Диагностика и лечение сердечно-сосудистых заболеваний при беременности – 2018. Национальные рекомендации. Российский кардиологический журнал. 2018, 3: 91–134. [Diagnosis and treatment of cardiovascular diseases during pregnancy 2018. National recommendations. Rossiyskiy kardiologicheskiy zhurnal = Russian journal of cardiology. 2018, 3: 91–134 (In Russ.)]. doi: https://dx.doi.org/10.15829/1560-4071-2018-3-91-134.

  15. Bartalena L., Bogazzi F., Braverman L.E., Martino E. Effects of amiodarone administration during pregnancy on neonatal thyroid function and subsequent neurodevelopment. J Endocrinol Invest. 2001; 24(2): 116–30. doi: 10.1007/BF03343825.

  16. Sessa M., Mascolo A., Callreus T. et al. Direct-acting oral anticoagulants (DOACs) in pregnancy: new insight from VigiBase. Sci Rep. 2019; 9(1): 7236. doi: 10.1038/s41598-019-43715-4.

  17. Hassouna A., Allam H. Limited dose warfarin throughout pregnancy in patients with mechanical heart valve prosthesis: A meta-analysis. Interact Cardiovasc Thorac Surg .2014; 18(6): 797–806. doi: 10.1016/j.ehj.2014.04.004.

  18. Xu Z., Fan J., Luo X. et al. Anticoagulation regimens during pregnancy in patients with mechanical heart valves: A systematic review and meta-analysis. Can J Cardiol. 2016; 32(10): 1248.e1–1248.e9. doi: 10.1016/j.cjca.2015.11.005.

  19. Sillesen M., Hjortdal V., Vejlstrup N., Sorensen K. Pregnancy with prosthetic heart valves – 30 years’ nationwide experience in Denmark. Eur J Cardiothorac Surg. 2011; 40(2): 448–54. doi: 10.1016/j.ejcts.2010.12.011.

  20. van Driel D., Wesseling J., Sauer P.J. et al. Teratogen update: Fetal effects after in utero exposure to coumarins overview of cases, follow-up findings, and pathogenesis. Teratology. 2002; 66(3): 127–40. doi: 10.1002/tera.10054.

  21. Beyer-Westendorf J., Michalski F., Tittl L. et al. Pregnancy outcome in patients exposed to direct oral anticoagulants – and the challenge of event reporting. Thromb Haemost. 2016; 116(4): 651–58. doi: 10.1160/TH16-04-0305.

  22. Lameijera H., Aalbertsa J., van Veldhuisena D.J. et al. Ecacy and safety of direct oral anticoagulants during pregnancy; a systematic literature review. Thromb Res. 2018; 169: 123–27. doi: 10.1016/j.thromres.2018.07.022.

  23. Hindricks G., Potpara Т., Dagres N. et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2020; ehaa612. doi: 10.1093/eurheartj/ehaa612.


About the Autors

Natalia G. Poteshkina, MD, professor, head of the Department of general medicine of faculty of additional professional education of N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia, therapist, consultant of City Clinical Hospital No 52 of the Moscow Healthcare Department. Address: 123182, Moscow, 3 Pekhotnaya Str. Tel.: +7 (910) 442-22-16. E-mail: nat-pa@yandex.ru
Malika N. Domasheva, clinical resident of the Department of general medicine of faculty of additional professional education of N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 123182, Moscow, 3 Pekhotnaya Str. Tel.: +7 (928) 022-95-27. E-mail: mdomashieva@mail.ru
Alla B. Khadzegova, MD, professor of the Department of general medicine of faculty of additional professional education of N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 123182, Moscow, 3 Pekhotnaya Str. (City Clinical Hospital No 52). Tel.: +7 (499) 196-19-69. E-mail: alla.h@mail.ru
Galina B. Selivanova, MD, professor of the Department of general medicine of faculty of additional professional education of N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 123182, Moscow, 3 Pekhotnaya Str. (City Clinical Hospital No 52). Tel.: +7 (915) 293-83-29. E-mail: galina.selivanova@rambler.ru
Natalia S. Krylova, PhD, associate professor of the Department of general medicine of
faculty of additional professional education of N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia, functional diagnostics doctor of City Clinical Hospital No 52 of the Moscow Healthcare Department. Address: 123182, Moscow, 3 Pekhotnaya Str. Tel.: +7 (903) 660-31-68. E-mail: krylova_n@list.ru
Anna M. Svanadze, PhD, associate professor of the Department of general medicine of faculty of additional professional education of N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 123182, Moscow, 3 Pekhotnaya Str. (City Clinical Hospital No 52). Tel.: +7 (916) 958-65-50. E-mail: asvanadze@mail.ru

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